Episode 13 – Dr. Emily Deans on Nutrition and Mental Health

Dr. Emily Deans’ Evolutionary Psychiatry blog has quickly become one of my favorites over the past year. It’s rare to find a psychiatrist that acknowledges the role of nutrition in mental and behavioral health at all, much less one that approaches these topics from an evolutionary perspective.

This week Dr. Deans joins us on the podcast to discuss the role of Paleo nutrition in mental health. Topics covered include:

The link between diet and Alzheimer’s

Can nutritional changes effect depression?

Does gastric bypass surgery lead to mental health issues?

Can gluten intolerance induce mental disorders?

What role does the “modern lifestyle” play in the increasing prevalence of mental health problems?

Full Text Transcript

Chris Kresser: Hey everybody. Welcome to The Healthy Skeptic podcast. This is Chris Kresser. And I’m here with Dr. Emily Deans, from the blog Evolutionary Psychiatry. And we’re going to talk about the role of nutrition and mental health. So welcome to the show Emily.

Emily Deans: Thanks so much.

Chris Kresser: So why don’t—before we get into the questions—we’ve got some really great questions that I’m excited to talk about. But before we get into that, I’m really curious to know more about your story. Like how you became an evolutionary psychiatrist because it’s certainly not the typical career path for a psychiatrist. And so I’m sure some of our listeners would love to hear a little bit about that too.

Emily Deans: Oh gosh. Well, you know it all starts with vanity probably, if I really have to get down to it. I mean, I’ve been interested in nutrition and sort of optimal health my entire career. You know—it always sort of followed the USDA and all those recommendations and worked out quite a lot, and tried to be healthy. It took an awful lot of work to stay in the same jean size—I have to say—all those years.

And then about in 2007 I read—right when it came out—I read Good Calories, Bad Calories. I read all the Michael Pollan books. And I sort of figured out whoa—you know—something’s really wrong here. And then I started having kids. As you’re well aware of Chris, everything sort of turns upside down when you’re pregnant. Or at least your wife is well aware of anyway.

Chris Kresser: Yeah, we both are at this point.

Emily Deans: Right. And, it was very interesting because while—you know— I’d worked really hard to kind of keep to a very normal weight before. You know—the hormones were everything and I ate real food, I ate the Michael Pollen food. I didn’t eat vegetable oils, I was keeping it to whole grains. And for each pregnancy—I had two in three years, I gained 75 pounds.

And in between—between the first and the second I was able to lose—it was actually quite remarkable. I lost 49 pounds in 49 days after the first one.

Chris Kresser: Wow.

Emily Deans: And, eventually got down to all but five pounds lost before the second one. But it was still—so that really, really sort of set things in stone. That this—that weight gain is hormonal. That—you know—calories in, and calories out and calculating everything and putting it all on fit day. And working out enough probably wasn’t going to do it. That it all had to do with something with a set point and how things were directing your metabolism.

And so after I finished breast feeding the first one I thought—you know—I still have—you know—some pounds to lose before I get back to my pre-pregnancy weight. And so I consulted with a Paleo sort of—Paleo style nutritionist. And it worked very rapidly and very well—faster than anything that I’d done in the past to kind of maintain my weight.

And at that point, I thought whoa—you know. In reading into it in Food and Western Disease, and Mark Sisson, and Stephan Guyenet’s blog—you know—I decided—you know—this has got to be—you know—really important with respect to mental health. What has been looked into this with respect to depression and bipolar disorder and behavior. And so I thought, I couldn’t really find that much on that.

So I decided well, you know—how many psychiatrists are there who have an evolutionary perspective and—you know—had some anthropology and nutrition training in college. Not too many, probably. So I started my blog, and you know, a year later, here I am.

Chris Kresser: That’s a great question you pose. How many are there? Do you know of any other folks out there that are approaching things in a similar way at this point, now that you’ve started doing it? Have you been contacted by anybody in your profession?

Emily Deans: Well there’s a psychologist in Oregon Ann Childers who’s been interviewed by Jamie Moore. She’s kind of a low carb. And she has a Twitter—she’s on Twitter, but she’s in Oregon. So we have the coats covered. And my—you know, the people in my—I work with four other psychiatrists and—you know—they’re all very excited. And also several other psychiatrists I know from practice all think it’s very, very interesting.

Emily Deans: We have therapy, we have—you know—the medications and they’re both—you know—probably sixty percent effective. So most psychiatrists really want to help people. They’re doctors—they want to—they got into, they really want to make feel better. And so, you know—everyone’s interested in kind of a new angle and a new idea. So, I actually have a lot of people interested in this. I don’t know if they’re all full bore into it like I am—you know—living it, but they’re definitely interested.

Chris Kresser: Well that’s great. I mean it’s good just to know that there is some interest. And I imagine it’s going to take a long time to change the paradigm. And of course we’re fighting against some pretty powerful interests that helped to define that paradigm.

Emily Deans: Well, I mean, I have to say—I sort of—one of my guru’s in medical school, a professor in psychiatry at Harvard. There are not that many of them. He was very excited about it. More really about the whole western medicine thing and the Kitavans necessarily then psychiatry itself because there wasn’t as much data. But he thought it was just fascinating and great.

And—but another sort of psychiatrist guru said—you know—I’m skeptical. And that’s because it’s pretty well established that stress plus genes causes a lot of the mental illness. So it’s hard to kind of imagine that our diets also are part of that stress. But if—you know—if you have an open mind I think it’s pretty easy to take it all in.

The link between diet and Alzheimer’s

Chris Kresser: Yeah, I agree. So let’s dive in, we’ve got some great questions. Some from your blog and mine and Facebook page. The first one is from Daria, I think that’s how you pronounce her name. And she asked, I would love for Emily to talk about Alzheimer’s if possible, and any links to diet and nutrition. My mother’s been diagnosed with Alzheimer’s and she’s been a vegan for years. So what do you say about that Emily?

Emily Deans: Well, Alzheimer’s is pretty overwhelming looking at the literature and pretty complicated. It’s gotten probably a lot more money I would say then some of the other psychiatric diagnoses. So there’s more papers—which isn’t always a good thing. And a lot of the papers are biased in favor of the lipid hypothesis. So you sort of really have to look at the papers with a skeptical eye before you can make any sort of sense of them.

But when it really comes down to it, probably the most brilliant paper that’s come out was very recent in the European Journal of Internal Medicine. It was actually by an engineer, Stephanie Seneff and some of her buddies who review the literature. And—you know—basically Alzheimer’s is a disorder of pathogens, inflammation and problems with fats in the brain. And what you really need is more fat in the brain and you need efficient mitochondria and you need a lack of inflammation.

And in order to do that you really—in my opinion, you know it isn’t—you know—it isn’t very well proven in a randomized controlled trial or anything—but you really need to be eating sort of a Paleolithic—I would say, you know—if you’re that far advanced a very high fat diet. A ketogenic diet to really get through the rigors of Alzheimer’s and to prevent Alzheimer’s I would say you really need to be doing a nutrient rich diet with plenty of Omega-3, plenty of Magnesium, non-toxic to avoid inflammation.

And I think there’s actually quite a lot of evidence in that direction. It just really hasn’t been put altogether except by Stephanie Seneff—the medical literature.

Chris Kresser: Yeah and it—you mention the ketogenic diet. I’ve seen some pretty interesting papers on ketogenic diet as potential treatment for Alzheimer’s. And, I mean for me, if it were myself or someone in my family I would absolutely want to try that before some of the other pharmaceutical alternatives. Because there’s—as most people know, no treatment that is working very well at this point.

Emily Deans: Yeah, I mean there are three or four acetylcholine esterase inhibitors that are FDA approved, but they don’t work that great. And one of them Namenda I’ve used a couple time—it’s always made everybody worse. So I’ve kind of backed off of that one. Aricept is sort of the old fashioned one. And it can kind of hold people in line for a little while, but it’s not great. You know, it’s not a cure or really anything corrective by any means.

So—you know—if I had—you know—if my parents were diagnosed with dementia, I’d be out there with the coconut oil, and restricting their carbohydrates. Partly because it seems very clear that it’s—part of the disorder is due to energy metabolism in the brain, and when you use a ketogenic diet in the brain you bypass one of the sort of hurdles into getting efficient energy metabolism in the brain.

You skip an entire complex in the mitochondria. So your mitochondria for the most part are much happier and burning more efficiently if you burn ketones instead of glucose. So it seems like a no-brainer if you have—you know—if you have cognitive impairment or Alzheimer’s, to at least give that a try.

And to avoid developing it in the first place, you really—you know—it’s a disease of inflammation of hyperglycemia. So you really need to kind of avoid all of those diseases of western civilization all of which can be avoided if you really follow a sort of a Paleo diet and lifestyle for as long as you possibly can.

Chris Kresser: Yeah, and I suspect—you know—as you said that the—a large portion of the brain—the dry banner of the brain is lipid, and DHA is especially important and if you’ve been a vegan for years and years you’re almost certainly aren’t eating any—you know—Daria’s mom certainly hasn’t had much DHA unless she’s taking algae supplements which very few people do.

Emily Deans: Right, and there’s actually a very interesting component with respect to the plaques in DHA in that the amyloid precursor protein sort of lines up to be cut. And it can be cut into a way that doesn’t make plaque or it can be cut in a way that makes the plaque that builds up in Alzheimer’s disease.

And if you have a brain that’s—you know—full of plenty of DHA—and literally, you need a lot of DHA in the brain. It’s something like 20 to 30 percent of your brain lipids. I mean, it’s more than you would expect.

Chris Kresser: Right.

Emily Deans: And if you don’t have the Omega-3 there and you replace it instead with Omega-6 or something else, things aren’t lined up correctly in the lipid rafts and how things are supposed to be. And the amyloid precursor protein is actually cleaved differently. And so, that’s part of why I object to the—there’s sort of a simplistic classification of Alzheimer’s as type three diabetes.

And while hyperglycemia I think definitely can increase the risk for having it, and maybe part of what you have to have to develop Alzheimer’s, it’s not the entire story.

Chris Kresser: Right.

Emily Deans: And I think being low on Omega-3 is also a very disastrous thing for your brain.

Chris Kresser: And of course—you know—these mechanisms are all connected. So you have high blood sugar and Omega-6 / 3 balance that’s out of whack, both contributing to inflammation which we know contributes to Alzheimer’s. So it’s a bunch of vicious cycles it seems like, acting on each other.

Emily Deans: Yeah, yup.

Chris Kresser: So what about this—you know—a lot of elderly people of course as they get older as soon as their cholesterol goes over 200 they get prescribed a statin which you know in a lot of cases will bring their cholesterol down even below 150. So what this connection, this possible connection between low cholesterol and Alzheimer’s?

Emily Deans: I mean I have to say I don’t why the primary care doctors still refer to me because I’m always taking people off their statins.

Chris Kresser: Good for you.

Emily Deans: I mean I’m always writing a very lovely informative and documented paragraph in my intakes that I then fax to the primary care doctors. But anyone who complains of any kind of cognitive complaint or memory issue or if their a woman, or if they’re diabetic. I’m like—no, you don’t need the statin.

You know—if they’ve had a hard attack in the past, or if they’ve had a stroke that’s—there is actually data to show that—you know—it might keep you from dying from another heart attack or stroke faster then you’re going to die from something else that the statin will cause. So, okay. Let’s not push it too far, though I think a dietary change would probably be preferable.

Chris Kresser: Right.

Emily Deans: But—you know—I think do have a lot evidence based medicine legs to stand on taking people off their statins. And I’ve taken several people with early cognitive impairment—they’re coming and it’s funny. They come to psychiatrist with their cognitive impairment but that happens, and I take them off their statin, and they improve.

So the primary care doctors—I have to say, a lot of them understand that it’s just the anti-inflammatory mechanism. They understand that cholesterol isn’t the entire story. They don’t like statins. They have to measure liver function test every three months. People always complain about them. It causes them to ache, they don’t like them, they don’t take them. They have to measure all their cholesterol all the time.

And so sometimes it’s not as hard of a sell as you might think. But—you know—with the Seneff paper which I have a blog on it. I think it’s called—it’s a blog from a couple weeks ago—something about nutrition and Alzheimer’s, the dangers of insulin resistance. And there’s a full text link there to the paper. And I think it really spells out a very scary scenario combining hypercholesterolemia with a statin to be sort of like a perfect storm to develop—sorry, not hyper—hyperglycemia with a statin.

And it develops a perfect storm for causing Alzheimer’s. And it’s really quite scary.

Chris Kresser: Yeah, I agree completely. And—you know—not to mention all the other potential complications and risks of having low cholesterol as you age. I mean a lot of studies, we know show that your risk of death increases when your cholesterol drops below 150, and you’re older than 65. And—

Emily Deans: Well yeah, I mean Paul Jaminet just did a blog on it with a great diagram from the world health organization data from 2005 in men. And it was showing that the lowest mortality I think was between 220 and 260 total cholesterol. Which is all high cholesterol according to the cardiologists.

And—you know—in Good Calories, Bad Calories in women mortality I think drops right up until you hit the total cholesterol of 300. And then I have a blog on low cholesterol and suicide where—you know—there’s pretty strong epidemiologic evidence that cholesterol less than 160 is associated with a violent death, accident, suicide.

Chris Kresser: All kinds of fun stuff.

Emily Deans: It’s not a very pretty picture, so—I don’t really see the sense. It’s funny because when I read Paul Jaminet’s blog I looked for some—I was trying to look for some more information in women, because I knew his graph was of men. And I found this Lancet article where they’d done this 20 year study and they found that the highest mortality was in the low cholesterol group.

And the authors were just nonplussed. They had no—they had all this desperate discussion to say it’s just a correlation, we don’t know what it means, it’s not the cholesterol, we’re sure—

Chris Kresser: Course not.

Emily Deans: I mean it’s really amazing once you get wedded to the lipid hypothesis how far you will go to sort of defend it.

Chris Kresser: Absolutely. So before we move onto the next question, I just wanted to say I’ve had some interesting very small anecdotal experiences so far treating early onset dementia with a ketogenic diet. And I do sort of a—the Jaminet Perfect Health version of ketogenic diet where it’s not as low carb as the typical ketogenic diet.

50 grams of carbs with—using MCT oil and coconut oil as well leucine—like five grams of leucine. And I’ve had some unbelievably strong results using that approach. I had an 83 year old patient who was really—had lost a lot of her short term memory.

And was falling down, losing motor function. Her gut was just a total mess. Probably because the gut-brain connection was awry. And she went on a kind of ketogenic version—I put her on a ketogenic version of the GAPS diet. And within ten days she was a different person.

Emily Deans: That’s amazing. That’s really remarkable.

Chris Kresser: It’s exciting. I mean, it’s obviously not enough to make any—come to any conclusions about, but she’s certainly happy.

Emily Deans: And I’m happy for her. You know, I can’t always convince everybody. When they come to a conventional psychiatrist MD and you start talking about coconut oil, they look at you like you have three heads, and they don’t always listen. You know—I haven’t had a whole lot people follow me sort of full blow and into Paleo.

The people who have done really well, I have to say. But I can’t convince every family—you know—with a mild cognitive impairment or dementia to go keto. Because it’s not easy, you know.

Chris Kresser: It’s a big commitment.

Emily Deans: Yeah.

Chris Kresser: And she’s fortunate because her whole family is onboard and she has their support and they’re preparing her meals. It’s a unique situation. Definitely a worthy experiment.

Emily Deans: Definitely.

Can nutritional changes effect depression?

Chris Kresser: So let’s go onto Jerry. He asks are gulping down probiotics and liver really a way to treat depression. Have you had any depressed patients that got better after you gave them nutritional advice in addition to or in lieu of medication or cognitive behavioral therapy.

Emily Deans: That’s a good question. And the literature probiotic’s itself is very scanty. There was a great paper published—I think in the Journal of Effective Disorders—I could be wrong, about sort of the theoretical gut-brain axis. In missing our old friends in inflammation, parasites, probiotics and all those things.

And they listed a lot of the studies that had been done. Most of them had been done actually in cancer. Where they would give people who are on chemotherapy who are liable to get depressed. They would give them mycobacteria— killed mycobacteria or probiotics and they had some differences between the placebo and the study population and how depressed they got during chemo.

But that’s pretty much it with respect to—you know—probiotics and depression. I have to say, my patients who—you know—take Activia or probiotic—no one’s come back to me—and oh like, my depression’s cured, I’m fine.

You know—that’s never happened in my experience. So I don’t think probiotics are the be-all, end-all for most people. It’s probably though a part. I mean, and that’s—by the time people come to see a psychiatrist, they’re pretty depressed and pretty desperate. I don’t know of too many people who’re going to say, oh, you know, I’m feeling a little down. I’m just going to go see a psychiatrist.

You know, usually they see their primary fist, or they try to see somebody else—or they try to kind of get through it on their own. So I see people who’re pretty far along. And there are a lot of things that are out of balance, and you really have to correct all of them along the line, before you can see a lot of improvement.

And I think that’s a lot of the problem with the literature. You try and make one intervention, and one intervention isn’t what it takes. You really need to address a lot things. And with our modern nutrient deficient diets you’re going to be low on magnesium, you’re going to be low in choline you’re going to be low in the phospholipids. You’re going to be in zinc. You’re going to be low in all sorts of things.

And if you don’t have all of all of those in place, it’s hard for your brain to work properly. So the literature’s not robust. I have to say, when I’ve been able to convince people—many of them I’ve seen for quite a long time now. And the people who’ve been most convinced are the ones who also have autoimmune fibromyalgia symptoms. So they’re really suffering on all fronts.

They also tend to be on the better educated side of things. Or they have celiac disease. And those people I’ve been able to kind of convince to go full-bore Paleo. And they have had most notably a vast reduction in medication—and not necessarily completely off mind you, but we’ve been able to really reduce it quite a bit. Also adding meditation and those kinds of things.

And then—they’ve also—I think what people have primarily described which I think is very telling. A great decrease in fatigue. So someone’s who’s tired and not motivated and fatigued all the time. You really think of an inflammation as causing this huge background of just wearing you down. You’re like a wet dish cloth that’s been wrung out and just thrown on the floor.

And when you put them on a Paleo kind of diet they really come to life in a more vibrant—and even if they still have some residual depression systems they’re doing a lot better. So that’s the success that I’ve seen. But no, I haven’t seen anybody just get a lot better with probiotics on their own.

Chris Kresser: Right. There was an interesting study—I don’t know if you saw it. It was in 2010, I think in the British Journal of Nutrition and it was on a couple of probiotics. Lactobacillus helveticus and Bifidobacter longum and they had a—they used a—the study was on rats and human healthy volunteers. And they found a significant decrease in anxiety in both the rats and the humans.

I thought that was interesting. But I completely agree that it’s one piece of a puzzle that can be very complex and have multiple moving parts. And it’s almost never in my experience about a single intervention, as you pointed out. But—you know—addressing things from not only the nutritional perspective, but—you know—the behavioral perspective as well.

Emily Deans: Yeah, and that’s a question I get quite a lot. You know—are you—this nutritional perspective it’s—nutrition alone, I’ve gone to this diet, it hasn’t cured things, etc, etc. And I have to say—you know—the therapy—you really have to approach this with the full bore.

You’ve got to take the shotgun out. And say look—you know—you’ve got to look at therapy and the way you’re thinking, and the way that you’re coping. And you’ve got to look at your nutrition, and you’ve got to look at your exercise, and you’ve got to look at your physical—you know—sort of medical health. And all of them really have to be in line to get your brain back in gear.

Chris Kresser: Definitely. I will say too, just anecdotally that one of the most significant and one of the quickest changes I see when people switch from a standard American diet to Paleo diet is in cognitive function and mood stability. Especially if it’s a higher fat Paleo diet. We’re not necessarily talking about clinical depression here. But just on a more—you know—a less formally diagnostic level. People seem to experience pretty big shifts in their mood and their cognitive function.

Emily Deans: Well I have to say—you know—my own personal experience shifting—it was always—I tended to be on the hypoglycemic side so it was always very difficult for me to maintain a 20 or 20 percent fat diet. I would always be kind of grouchy and I’d have to eat all the time. And it was—and so just accepting the need for butter and coconut oil, and just throwing them on the eggs and just—you know—hey that’s cool.

It’s been very healthful in my life. It’s nice not to have to eat every three years. You’d always have to have a—you know—string cheese and an apple in your bag. I forgot it. Oh my God, it’s three o’clock.

Chris Kresser: I’m going to die.

Emily Deans: I feel sick, so you know. So it’s really nice—you know—the worst comes to worst, you grab a little square of chocolate at four, you know. It’s much more relaxing to be on the higher fat side of things for me personally.

Chris Kresser: Yeah, I had a similar experience. I used to be pretty moody and didn’t fully—you know, thought that maybe that was my personality. Until I started doing a really high fat diet. And then I just had—just felt really rock solid in my moods and could go for long periods without eating and not freaking out and not feeling like I was going to pass out or die if I didn’t—you know—eat food right away. I’m sure the people around me appreciated that change too.

Does gastric bypass surgery lead to mental health issues?

Chris Kresser: Okay let’s go on to Beverly. She says, question for Chris and Dr. Deans. I’m a nurse on an acute psychiatric unit. I’ve long had an interest in nutrition and mental health. We often have patients that are several years out of gastric bypass surgery who are psychotic. Is there any research being done on the long term effects of this surgery. It seems that radically changing the guts functioning would lead to mental health issues because of disruption of the gut-brain axis.

Emily Deans: So I really like this question. It’s one of my interests too. And I think I want to start with sort of an overall perspective on western civilization and the idea obesity. When you really look at sort of a—because this is what a psychiatrist does. We think way too much about sometimes the causatives and the motivations behind everything.

But when you look at the diets that have been recommended over the last forty years plus—eventually leading to this gastric bypass surgery. I mean the diets—you know—they kind off—they suck. They’re hard, they’re not tasty. It’s like a punishment. Low calorie, lots of cardboard that you have to eat. If you’re diabetic you can eat cardboard—you know—like five grapes—and olive oil. And that’s—and a fat free skinless chicken breast that you charred in a—you know—George Foreman.

I mean that’s—it’s a horrible existence, day in-day out—eating that stuff. And—I’m a little biased—maybe other people enjoy that, but not I.

Chris Kresser: Hard to believe.

Emily Deans: And then, if you fail at that which—who wouldn’t because it’s unpleasant to the extreme and is that your entire life? You know if you do succeed at that, there’s probably something unusual about you. And it’s only—that’s the thing. And that’s how you come in western medicine to this idea of the gastric bypass. Which when you sort of look at from the outside it’s really appalling.

You know, lets remove half of our upper intestine and our stomach and call it a success. I mean It’s a really appalling major surgery that you have to do. But when—from the other side of this—from the western medicine kind of evidence based medicine perspective, none of the diets work. Low carb, high carb, Mediterranean, everybody gains back their weight in five years.

You’ve got diabetes—you know—that in the long term—and this is what doctors like myself see, and I think why we have a little bit of a different perspective in all these interventions. You know—everyone’s always looking for the next supplement, and the next this and the next that. But we’ve seen the other side where—you know—Kurt Harris and I—where we’ve seen all the problems that can come from medical interventions.

And—you know—when you look at long term diabetes, you’re talking blindness and kidney failure and—you know—it’s horrible. Your feet are rotting off and uncontrolled diabetes is a very slow, very disruptive, very horrific disease to have.

And so—you know—from a doctors perspective if you can prevent that by lopping out someone’s—half of their stomach 20 years earlier, it seem like a more reasonable option from sort of the outside. And it’s the only—and this is the sad state of evidence based medicine. It’s the only evidence based medicine that works. The gastric bypass. For people with—for example—with more than a 100 pounds to lose.

Or more—or who are obese with a lot of complications. Such as hypertension, diabetes and those kinds of things. And other things come with diabetes that we see all the time. People come in with these horrible flesh eating infections and these—you know—boils that you have to—it takes weeks and weeks of IV antibiotics and you have to surgically remove them.

I mean it’s really horrific. So you can sort of see how from a doctors perspective how a gastric bypass becomes suddenly sensible. When from the outside it seems crazy. You know. So when you look at a gastric bypass there are a lot of nutritional issues. I think they’re better at addressing these now, then they were in 1995 or whenever they sort of started doing it.

And if you look at the literature there are many, many stories of psychosis and depression and suicide after gastric bypass. Most of them are related to Thiamine deficiency they think. Or a stricture that develops that develops—like a complications of surgery, where the person isn’t absorbing any food at all. And some of these happen late. There was a case study I was reading of—it happened seven years after surgery.

And they call it a Wernicke’s encephalopathy which is a thiamin deficiency. And they cured it with thiamin. And the person was acutely psychotic seven years after their gastric bypass. And again, there are several stories in the literature about this.

There are also stories of neurological complications from copper deficiency. I know I have several patients who’ve had a gastric bypass who have to go in and get B12 shots plus iron infusions—IV, because they don’t absorb them. And you think of a lifetime without half of your gut. Which our guts as humans are already pretty short compared to other primates.

Chris Kresser: Yeah, exactly.

Emily Deans: They’re already kind of optimized for maximum efficiency. I would think there would be a lot of complications. So you know—if someone comes to me and they say, hey—you know, the doctor says I’m 80 pounds overweight—you know. They’ve had a lot of success with their patients doing a gastric bypass. I do tend to say, well, maybe try this Paleolithic diet first. Here’s the Primal Blueprint, here’s the Perfect Health Diet. Read into it, because it seems to me that it would be a reasonable approach to try before you have half of your intestinal organs lopped out.

Chris Kresser: Yeah, I mean I couldn’t agree more. And it’s Jenny—Jenny wrote a diabetes update—actually wrote a little bit about this today. I don’t know if you saw her post. She had some links to studies that linked the gastric bypass to an unexpectedly high rate of suicide.

Emily Deans: Yeah, I saw that one. That the suicide is mostly in the first two years. And that’s the other thing is—once you’ve had a gastric bypass you can’t ever eat the same.

Chris Kresser: Right.

Emily Deans: You know—and that’s such an amazing huge change in the life of a Homo Sapien. You know, you can’t go to Christmas dinner and have—you know—all the turkey you want. You can’t—you know—it’s never going to be the same. And that’s a huge change.

They’ve required now for all gastric bypass, you’re required to have a psychiatric evaluation before you have it done. And they’re also I think better at these—at repleting the nutrition. So, I think there are fewer complications now than there used to be. But I don’t know about 10 years, 12 years out. What do you do 12 years without enough copper. 12 years without quite enough Thiamine. I mean, I don’t think we really have the data on that.

Chris Kresser: Yeah, and that’s assuming that—you know—the medical system stays completely intact the way it is. And then you become completely dependent on it. And that would be pretty scare to me. I mean I would consider just about any other option before I did that.

Emily Deans: Well, sure—I mean yeah, you have to have B12 shot or you’re eventually going to die. That’s pretty scary right?

Chris Kresser: Yup. Yup.

Emily Deans: And so while from the western medicine perspective there is a place for a gastric bypass especially compared to the conventional treatments. You know, when you really compare it to an evolutionary medicine perspective it falls short in every kind of way.

Chris Kresser: Yeah.

Emily Deans: And there was one more thing I wanted to mention. They did do a study four years out of depression and gastric bypass and for the majority of the people the depression that they’d had when they were severely obese and very sick was decreased after four years. So I did want to mention that. Because it’s fair to kind of mention both sides. But that’s four years, so you know, who knows about 10, 12, etc.

Can gluten intolerance induce mental disorders?

Chris Kresser: Right, yeah. Okay this is from, I think Milad. And he asks—he or she ask—can gluten intolerance induce mental and bipolar disorders? I know someone who has a GI Tract manifestation of gluten intolerance, and this person has a sister who almost always had bipolar disorder made worse perhaps by medication. What do you think about this? Thanks a lot.

Emily Deans: Well I really do—and I think like every other Paleo blogger, wheat is kind of our nemesis. Because we have a lot of suspicions and a lot of smoke at the fire but we can’t quite—you know—there’s the gun, you know. And there are a lot of—Kurt Dohan and Faith Dickerson are two researchers who’ve done a lot of research into gluten and schizophrenia and gluten and bipolar disorder.

And they’ve found a lot of very mysterious things. That for example on an inpatient unit in the sixties they put one inpatient unit on a gluten free diet and the other in patient unit on their regular diet. And lo and behold the people on the gluten free unit were released—you know—twice as fast—they were healthier and ready to go back into the community as the people on the regular hospital diet.

And Faith Dickerson has found is that in the urine of schizophrenic people there are a lot of weird gluten derived proteins. Some of these are very different from the ones that you will find in Celiac disease. And they’re very different from what you would find in people who don’t have schizophrenia. And what the heck are they doing there? Is it the gluten itself that’s the problem? Is it the wheat? Or is it that people with schizophrenia have leaky guts? Is it an inflammation issue?

I mean, nobody really knows. It’s just the finding. And I don’t—there aren’t a whole lot of—let’s just say the literature is not robust. However I have heard sort of off the record and in comments and kind of looking around the internet, that many people when they drop gluten—their mood swings get better. Their bipolar disorder gets better, they can go off meds, they can do—so, you know—it’s not something that people always buy from me when I tell them.

But people who go gluten free, there is a chance out there that their mood disorder might get better, from the case studies that I’ve heard. And to me, I don’t see why you wouldn’t try it.

Chris Kresser: Exactly. There’s no down side. We don’t require wheat for our survival. So certainly eliminating for a period of time—it’s hard to argue against that.

Emily Deans: Yeah, and I mean, there’s a lot of stress. About, oh, we’re eliminating wheat. And you know—I don’t quite get it. You know there’s this—if you’re trying to do a gluten free, casein free diet for kids with autism for example. There’s all these warnings—you know—they’re going to get nutrient deficient, etc, etc. And I’m sort of—you know—I don’t see it. I do eat wheat every now and again, I have…

Chris Kresser: Gasp!

Emily Deans: Oh my God.

Chris Kresser: 80-20 rule, right?

Emily Deans: Right. It’s not that often, and it’s not a big deal for me. I know people—there are people who love bread. They can’t imagine life without bread. And I’ve had some discussions where there are just—they talk about bread—it’s like people talking about their heroin.

Chris Kresser: Yeah, exactly.

Emily Deans: They’re like, the fluffiness of it, the smell of it. Leading up to it, and I break open the bread, and the little kernels split open, and I smell it. And then I put butter on it—you know—of course—or margarine, or whatever horrific thing they put on it.

Chris Kresser: Well yeah, right, let’s hope not.

Emily Deans: But that’s—you know—I could really care less if I didn’t eat bread. So it’s interesting the different experiences that people have. And that could be because of the opiate issue with bread. And I do have actually some success with treating night binging on bread with an opiate blocker called Naltrexone. Which is—

Chris Kresser: Are you using the lower dose?

Emily Deans: No, I’ve used the 50mg. Which is what we use for opiate dependents.

Chris Kresser: Right.

Emily Deans: So, that’s kind of what I’m comfortable with.

Chris Kresser: Right, yeah. Bring out the big guns.

Emily Deans: Right, and—you know—I think the lowest pill you can get is 50mg, at least prescription.

Chris Kresser: Right. Yeah, that’s interesting. I mean, I’ve certainly and—like you said, when you look at Robb Wolf’s like—or Mark Sisson’s site and all the testimonials there. And certainly in my patient population, I’ve had a lot of pretty dramatic improvements with people just removing gluten from their diet. Way more than they could have predicted or imagined.

Emily Deans: Yeah, and I’ve had people approach me privately. People who are really sort of highfalutin in the Paleo movement. Because they’re talking about family members or themselves. And they said—you know—I was really kind of off the wall before. Had a lot of mood swings, a lot of depression and when I dropped gluten, all of that changed. And I think that’s an important finding and we need to pay attention to that.

And it’s painless finding in the overall history of the world. You know, dropping gluten is not the end of the world. And I think the nutritional sort of USDA and all that kind of thing need to catch up with that, and figure that out. Because I think it could be tremendously helpful for a lot of people for a lot of different health conditions.

Chris Kresser: Absolutely.

Emily Deans: Autoimmune and mental health and etc, etc, etc.

Chris Kresser: Especially in kids. You know, because to start medicating kids with behavioral disorders when they’re four, five, six years old without trying something like this just strikes me as crazy.

Emily Deans: Yeah. It’s very disturbing. I’m not a child psychiatrist. And it’s a very—there’s not a great deal of data for them. I feel for the child psychiatrist because the data is poor. And they’re dealing with very difficult situations. And you have a kid with ADD—really bad ADD who’s six for example, and he’s already making everybody in his class angry. So—you know, because he’s always in their face, or he’s running around, and disrupting everything so he doesn’t have friends.

And he—you know—he’s at higher risk for divorce, car accident, suicide, depression. And so again this medical model comes in and says. Treat early, treat aggressively. And there’s not the evidence for—you know—until recently the evidence for dietary interventions was pretty scanty.

So you can see from this sort of western medicine perspective aggressively treating a preschooler, seems like the right thing. Because you don’t want them to start to develop all these problems. And then have a higher risk of suicide—I mean people with ADHD—boys with ADD are something like 21 percent of them in this one study had committed a felony by the age of 20.

I mean, it was bad.

Chris Kresser: Yeah, it’s a real problem.

Emily Deans: So you think about being in jail the rest of your life, versus the risk of being the risk of being on Ritalin form the time you’re ten. Well being in jail is probably worse. But, when you put that aside and think from the very large perspective. And think, okay, let’s try an evolutionary diet. Getting them out. A different approach—a more flexible approach. It seems like the more flexible dietary approach is a very obvious way to address it first.

Chris Kresser: Yeah, I agree. And again. I mean, The GAPS approach—for those of you who aren’t familiar with it. It’s created by a doctor from Russia who now lives in the UK. Her name’s Natasha Campbell McBride. And she had a—I think her son was born—developed autism. And she researched the treatments that were available at that time. This was—I think her son’s like 18 or 20 now. So this was quite a while back.

And she developed this hypothesis that autism and other behavioral disorders had some link to gut health. And so the GAPS diet—you know—which she developed—and, or based on the specific carbohydrate diet, removed not only gluten, but all grains.

And all disaccharides and polysaccharides. And if you go on the like Yahoo group for the GAPS diet. You will see reports from parents all over the world that are having huge, huge success with this approach. With kids with everything from ADHD to autism to schizophrenia, to depression, anxiety—you know. And pretty much any disorder.

And again, I mean, that’s not cold hard double blind placebo controlled evidence. But, for these parents, and you know, a lot of parents that I work with. When they consider what the alternatives are, it doesn’t make sense not to at least give it a 30 day trial. I mean it’s—

Emily Deans: I agree 100 percent. And I should bring up here, really the best of any sort of Paleo intervention for any psychiatric disorder. The best evidence is actually an ADHD. In what was called the Inca trial in Belgium. I think in February of 2011 they took a 100 kids, they put 50 of them—it was—the whole idea was to put them on anti-inflammatory, anti-allergenic diet.

But they ended up putting them on—all they could eat was rice, meat, vegetables, water and pears. And they could have small amounts if they tolerated of wheat, potatoes and other fruits. But for the most part they were stuck with those five primary things. And they put them on this diet for nine weeks. These fifty kids.

And all the kids had been diagnosed fairly rigorously with ADHD. And their behavior and attention improved quite a bit after the nine weeks. Then they switched over. They had 50 kids on a control kind of Belgium USDA diet. And they switched the control kids over to the intervention diet, and they switched the intervention kids over to the control diet. And there were more complications to what they did because they tested them for IGG allergens. Which is probably useless as you and I agree, I think.

But they tested them so they knew it would introduce the different allergens and it made absolutely no difference in their behavior. It was really just going from this very restricted antiallergenic—what many of us would call a sort of very Paleo friendly diet. To a regular old USDA sort of Belgium diet that caused their symptoms to come back.

Chris Kresser: Right.

Emily Deans: So, I mean 60 percent reduction is tremendous.

Chris Kresser: Especially considering there are no side effects or risks associated with that treatment.

Emily Deans: Right, other then—you know—I have two little kids and when they want candy. I mean, it can very disruptive.

Emily Deans: And when you have a severely autistic kid, you can’t judge. I mean, you have to pick your battles. And some of them are very restricted in what they will eat. And from one side, you have to say, gosh, you have to try this—why wouldn’t you?

From the other side, they’re say—you know—my kid bangs his head. You know—he has to restrained in four point restraints if we don’t give him his—you know—fruit loops or whatever it is. And when you kind of look at it from that approach, you have to really sort of suspend judgment. People will have to do what they have to do, and you have to meet them where they are.

But, from a sort of a general population perspective, I agree. We have to try these dietary interventions that are inexpensive and not harmful. Before we—you know—try all of these other pharmacologic or other sort of useless interventions that don’t work.

Does iron deficiency anemia contribute to mental health problems?

Chris Kresser: Okay, let’s do one short questions, and then we’ll finish up with a more—a meta question. Which I think will be a nice way to finish. So the short one is from Mind Flair. Interesting handle there. Can you please discuss the role that iron deficiency anemia has on psychiatric issues?

Emily Deans: Well, that’s pretty straight forward. Because when we make our neurotransmitters we have to have iron. You know, if you’re making serotonin, if you’re making dopamine, if you’re making norepinephrine. If you’re making acetylcholine, all of these are neurotransmitters that effect the communication in the brain. And if you do not have iron as a cofactor for the enzymes that—turn the protein that we eat into these different neurotransmitters, you’re not going to make them.

So I’ve had patients who when they get iron deficient, become extremely moody, extremely tired, extremely depressed, they can’t sleep. The minute you replete the iron, they do better. Also with low iron or low ferritin you’re much more likely to have sleep disorders. Restless legs. Especially if you don’t have good sleep, you’re not going to have good mental health.

All of the same areas of the brain, the same neurotransmitters are involved with good mental health as with good sleep. So if you do not have iron, it is very difficult to have good mental health. So it’s pretty straight forward. You need to have iron, and if you have iron deficiency anemia, something going wrong. You know—you’re not absorbing it. You’re bleeding from somewhere.

You know—just because you’re a woman and you have a period does not mean you should have iron deficiency anemia.

Chris Kresser: Right.

Emily Deans: That’s actually one of the complications of a couple of my patients that have had a gastric bypass. You know—they get severe iron deficiency. They can come in, their eyes are sunken, their skin is grey. And I’m like—when’s the last time you went in for an iron infusion.

Oh, I forgot to do it, you know.

Chris Kresser: Right.

Emily Deans: It’s been like five months. You know—no one’s checked it. I’m like—get out of here, you don’t need me. You need some iron.

Emily Deans: It’s like you’re on top of Everest down at sea level without the adaptation.

Chris Kresser: Suffocating.

Emily Deans: Yeah.

How does an individual’s mental state influence his/her biology?

Chris Kresser: Okay, so. Last questions from Jacquie. I’m interested in what kind of interface you see between biology and each individuals thoughts, feelings and actions. To clarify, thoughts, feelings and actions are able to influence biology, e.g. the use of dialectic behavioral therapy can influence neural connections and the healing of complex PTSD personality disorder. Conversely nutrition can influence thoughts, feelings and actions. Reducing inflammation helps with the lived experience of depression. While I definitely I see Paleo non-toxic nutrition as one strand of future mental health care, it’s not the only strand. I get a bit worried about privileging biology in such a complex area as I don’t see it as being very far removed from the old style medical model. Just substituting diet for meds.

Emily Deans: Yeah, it’s a great question and I agree with her. Because a lot of times I’ll get those questions. What supplement do you use for PTSD? What supplement do you use for this? And sort of the overall meta answer is, there is no supplement. You know—you create a resilient brain by making a resilient human being with a loving environment from birth. And you know—micronutrient and plenty of fat, and plenty of magnesium, and plenty of everything they need from birth.

And they don’t have any trauma. And then you get this sort of glorious resilient human being. But who’s also trained to kind of meet adversity when it comes. And that’s the sort of—ultimate human being I suppose. Who wouldn’t have any mental health problems whatever they faced.

That’s not always what we’re given. So it’s always a combination of proper nutrition. If you’ve had traumas in your past. If you need some help in sorting out how you think about things, getting the right therapist. The interesting thing about therapy—there’s been a lot more data cognitive behavioral therapy for certain things. DBT for other things, but when you really compare therapy to therapy, they’re all about the same. And they’re all fairly equivalent to medication. Though the benefits of therapy can last a lot longer than the benefits of medication.

But it’s all—you know—when you look at the treatments it’s about 60 percent effective across the board. So finding the right therapy, find the right way of thinking about things. The right way of coping things that works for your environment, for your life. It’s all exceedingly important. And the reason the I focused—to be perfectly honest, the reason that I focused on the nutrition element is because I—there—you focused on it Chris.

But there aren’t a whole lot of other psychiatrists or people in the mental health field who focus on things in the way that I would like to see it focused on. In a very evidence based, very skeptical kind of approach. Whereas—you know—there are plenty of fabulous blogs on psychotherapy. On psychiatry. You go on to psychology today, where I have a blog.

You know, there are a hundred blogs there. That address all of these other issues. I don’t address it that much on my blog, but it doesn’t mean that I don’t think it’s very important. And meditation, mindfulness, these approaches to life of serenity. I think are extraordinarily helpful. They’re not always taught when you’re growing up in sort of a western society.

But I’ve spent some time teaching mindfulness and stress reduction and how to breath and how to meditate. And it’s extraordinarily helpful. I’ve had patients who were on tons of medication. And couldn’t leave the house. They could only leave the house to come see me, or their therapist. Because they knew that if they had a panic attack in our waiting room—that I’m a psychiatrist, I would probably know what to do.

But they couldn’t go to the grocery store, they couldn’t go to work, they couldn’t go to their kids graduation. They couldn’t go anywhere. And starting a meditation program after a time—they’re completely cured. They could go back to work, they could go out, they could go shopping, they could go to the grocery store, they could come see me. Over time we reduced all their medications to nothing.

So things like mediation can be extraordinarily powerful. So I don’t want to ignore all these things. I just—I don’t write about them mostly because other people would do a much better job of writing about them.

Chris Kresser: So for people who interested in learning more about mindfulness practice you can check out Mindfulness Based Stress Reduction. It’s John Kabat-Zinn’s work. He does a really amazing clinic at the university of Massachusetts—he’s been doing a lot of great research for 20 years. You can—

Emily Deans: He’s a great book—I’m blanking on the name right now. I’m sorry. I interrupted it because I thought I would remember the name.

Chris Kresser: His book—

Emily Deans: Yeah, it’s called—

Chris Kresser: Full Catastrophe Living.

Emily Deans: Full Catastrophe Living, yeah. I had that book. It’s a great book.

Chris Kresser: It’s a great one. Yeah, and there’s—

Emily Deans: And BSR is what I was a teacher of for a while.

Chris Kresser: Right, I figured that’s what you were talking about.

Emily Deans: Yeah.

Chris Kresser: And then there’s—you can go—actually he sells CD’s which have recordings of the body scan. And the guided yoga and guided meditation at Mindfulnesstapes.com, they’re only 30 bucks for a set I think. I use them a lot in my practice, I’ve a lot of success with them. I’ve done the training myself as well. It’s a big part of my—keeping myself healthy.

Jacquie’s question too, just reminds me of how important it is to approach this individually. Not only—you know—physiological, but mental health of course. And one of the reasons I wrote the nine step series is because I see a lot of people in the Paleo, primal world, just obsessively focusing on nutrition almost to the exclusion of all else.

So you know, they’re putting all of their energy into squeezing out the last one or two percent of benefit they’re going to get from making dietary changes. Or—you know—taking this supplement or that supplement. And meanwhile, they’re not sleeping, they’re not having any fun or enjoying life. They—

Emily Deans: People worry so much about—you know—can I eat this banana?

Chris Kresser: Right.

Emily Deans: And you know—just eat the banana. I’m sure you’re going to be okay.

Chris Kresser: Eat the banana, enjoy it while you’re eating it. And—you know—go outside. Or like—get a massage, or get some exercise, or whatever it is. Like, there’s a lot of things that go into what makes us a healthy human being, as you pointed out. And so, it’s not ever easy to answer the question like—what supplement should I take? Or what should I do? Because there’s always—we don’t live in a vacuum.

We live in a rich context of work and relationship. And—you know, relationship with others, relationship to yourself, our nutritional status and all of these things—you know—play a really significant and important role.

So, just a reminder of how unique we are as individuals and how much that needs to be considered when we’re asking and answering—trying to answer any of these questions.

Emily Deans: Yup. Hallelujah.

Chris Kresser: Hallelujah. So Emily, why don’t you tell my listeners where they can find out more about you, your blog address, and—so they can come check you out if they haven’t already heard of you.

Emily Deans: Well my crazy off-the-cuff first draft blog is at Evolutionarypsychiatry.blogspot.com. It’s one of the blogger blogs. And then I have a more refined, kind of second draft blog that I get paid for. So click over there please at Psychology Today. But you go over to the—you Google Psychology Today and go to their blogs and search for evolutionary psychiatry, and find my blog there.

Chris Kresser: Which are all fantastic, and I highly encourage you to read them. Emily has become one of my favorite bloggers and we’re super excited to have you on the show today, and we hope you can come back sometime soon.

Emily Deans: Well I was really excited to be on this show. I mean it’s a pretty elite group who gets to be the HealthySkeptic. It was a great opportunity to be a member of that group.

Chris Kresser: We’re flattered you came. And just—you all probably noticed we’re missing my wing man Danny today. He couldn’t be here. He was really sad that he couldn’t make it, because he was excited to interview Emily. And my blog of course is the HealthySkeptic.org. And thanks for listening. We’ll see you next time.

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Thank you for addressing my question on the podcast concerning Alzheimers and nutrition. I’m happy to report that my mother is now transitioning to a paleo diet and I have her taking coconut oil and fish oil daily!

Lauren – ketogenic diets as practiced old school for children with epilepsy had many complications including kidney stones, death from selenium deficiency, etc. I do think Paul and Shou-Ching Jaminet have circumvented some of those downsides with his plan. I would encourage you to find some professional nutritionist help to make sure Mom is getting all the nutrients she needs.

Thanks for listening everyone! Smgj – no question iron is vital, but it is a substance where too high and too low are both very toxic. Too high chronically is associated with increased hypertension, heart disease, and possibly increased risk of infection. Too low and you can’t oxygenate your tissues or make many neurotransmitters.

Mark – I have a lot of articles on Alzheimer’s and dementia on my blog. I am positive that a ketogenic diet will not help everyone suffering from the disease – on the other hand, Western medicine offers no method of prevention and no cure (NIH or IOM or someone convened a panel last year with that conclusion). In the face of devastating and fatal neurologic condition, it seems reasonable to recommend a ketogenic diet (carefully done, and I do rather like the PHD style ketogenic diet as it is more flexible with respect to carbs and protein) – as it is at the least (when carefully done) unlikely to cause harm, and there are many case studies and one small pilot RCT showing it to be helpful.

As for prevention, I can only look to the Kitavans, who have no dementia, and no one on the island knew anyone who recognized symptoms of dementia or had died of those symptoms when Staffan Lindeberg was there. No doubt it is a combination of factors, but I think a toxin-free nutrient-rich diet is probably a key one.

Thanks John – that looks interesting!

Henry – not sure what you mean. Insulin resistant generally refers to a metabolic condition “Glucose intolerant” could mean something similar to insulin resistance, or it could be that one’s stomach doesn’t like polymers of glucose in some forms.

Let me clarify. For someone that was insulin resistant for an extended period of time and no longer is, but it could be possible that the damage once done has a lasting effect?

I was obese (insulin resistant) for about 8 years and have been healthy for about 4. I sometimes feel I don’t tolerate too many carbs any more, compared with someone eating a starch-rich diet (like the one Stephan Guyenet eats). Jimmy Moore and Kurt Harris talked about this when Harris was on his podcast some time ago.

Henry….it might take some ‘training’ eating&tolerating more carbs again. I suffer from it too,actually lots of people being low-carb for a while. You might want to check out some articles on 180degreeshealth (Matt Stone’s site),he also has an E-Book called 180DegreesDiabetes with some interesting info.

I was so interested to hear about the possibility that a ketogenic diet could be helpful for those (like my mother) who are showing signs of dementia. Do you suggest following the ketogenic diet exactly as described in The Perfect Health Diet or should one tweak it in any way?

I just want to say how thankful I am for this podcast! So nice to hear Emily’s voice-it is as kind and intelligent as her writing suggests. Keep up all the good work. On a side note, I ran across a book I thought you guys might both enjoy by a woman who advises for the t.v show “House”. It details the investigative process as regards medicine and focuses in particular on the place of the physical exam and it’s relevance in modern medicine. All the best, John

I was very impressed with Dr Emily’s take on nutrition and how it affects people in a psychological way. I believe it does change your mood when you eat poorly and don’t exercise. I’m still not convinced that your diet can change whether or not you will suffer from Alzheimer’s disease.I have read that A Ketogenic diet can help reduce seizures for epileptics, so maybe there is something to it. Great interview, very informative, and I do hope you have her on again.

Great podcast! I didn’t realise the importance of iron. I’v always been in the bottom-low part of “normal” and this has always been downplayd by my MDs … Now I’m angry! I believe my hashimoto’s treatment always would have been sub-standard without my new MD, which put me on dessicated thyroid and iron + vitamin D + vitamin B supplements.